Organization
MID-VALLEY DENTAL ASSOCIATES, LLC
Active
Parent organization
MID-VALLEY DENTAL ASSOCIATES
Organization subpart
Yes
Provider details
NPI number
Legal business name
MID-VALLEY DENTAL ASSOCIATES
Authorized official
SHAWN R GRIFFIN (ADMINISTRATOR)
(541) 929-5227
Entity
Organization
Contact information
Practice address
3385 CENTER ST NE, SALEM, OR 97301-4609
(503) 585-2030
(541) 929-7649
Mailing address
3385 CENTER ST NE, SALEM, OR 97301-4609
(503) 585-2030
(541) 929-7649
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D7915
OR
1223G0001X
General Practice Dentistry
D9084
OR
1223G0001X
General Practice Dentistry
D9107
OR
1223G0001X
General Practice Dentistry
D9451
OR
1223G0001X
General Practice Dentistry
D9586
OR
1223G0001X
General Practice Dentistry
D9614
OR
Other
Enumeration date
08/12/2011
Last updated
08/12/2011
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